From the FDA Drug Label
- 2 Potential for Bupropion Hydrochloride Extended-Release Tablets (XL) to Affect Other Drugs Drugs Metabolized by CYP2D6 Bupropion and its metabolites (erythrohydrobupropion, threohydrobupropion, hydroxybupropion) are CYP2D6 inhibitors Therefore, coadministration of bupropion hydrochloride extended-release tablets (XL) with drugs that are metabolized by CYP2D6 can increase the exposures of drugs that are substrates of CYP2D6. Such drugs include certain antidepressants (e.g., venlafaxine, nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, and sertraline)
When taking bupropion (Wellbutrin) XL 350mg and fluoxetine (Prozac) 20mg together, it may be necessary to decrease the dose of fluoxetine, as bupropion is a CYP2D6 inhibitor and fluoxetine is a substrate of CYP2D6. However, the exact dose adjustment is not specified in the label.
- Key considerations:
- Bupropion may increase fluoxetine exposure
- Dose adjustment of fluoxetine may be necessary
- Monitor for increased adverse effects of fluoxetine 1
From the Research
Yes, fluoxetine (Prozac) 20mg and bupropion (Wellbutrin) XL 350mg can be taken together, as this combination is sometimes prescribed by healthcare providers for certain patients with depression. This approach, known as combination antidepressant therapy, may be used when a single medication doesn't provide adequate symptom relief. However, this combination should only be used under close medical supervision due to potential drug interactions. When taken together, these medications can increase the risk of seizures and may potentially lead to serotonin syndrome, a rare but serious condition characterized by agitation, confusion, rapid heart rate, and high blood pressure. Additionally, bupropion may increase fluoxetine levels in your body. If you're currently taking one of these medications and considering adding the other, consult with your healthcare provider first rather than making this change independently. They will need to monitor you closely, especially during the initial combination period, and may need to adjust dosages based on your response and any side effects you experience, as seen in a study where the combination of antidepressant medications from treatment initiation for major depressive disorder showed significant improvements in symptoms 2. It's also important to note that the combination of bupropion and SSRIs, like fluoxetine, can induce serotonin syndrome, although this is rare, as reported in a case study 3. In terms of efficacy and safety, a study found that the combination of escitalopram and bupropion-SR was effective and well-tolerated in patients with chronic or recurrent major depressive disorder 4. Another study suggested that the combination of bupropion and sertraline was effective in refractory depression, with no adverse effects reported 5. However, the safety and efficacy of this combination should be closely monitored, as the risk of adverse events, such as serotonin syndrome, cannot be ignored, and the benefits of combination therapy should be weighed against the potential risks, as noted in a study on the changes in adverse events reported by patients during 6 months of fluoxetine therapy 6.